Geauga Soil and Water Conservation District

Application for Review and Approval of a Water Management and Sediment Control (WMSC) Plan (RESIDENTIAL ONLY)

All information, as applicable, must be provided on this form. The review fee shall be submitted with this application and associated plans. Plans will not be reviewed until the fee has been paid and application and plan submitted.

OWNER INFORMATION

Owner Name *

Owner Mailing Address *

City *

State *

Zip Code *

Owner Phone Number (Cell/Home) *

Owner Cell Number (if home number was previously provided)

Owner Email Address *

CONTRACTOR/HOMEBUILDER INFORMATION

Is the owner the Contractor/Builder? *

Yes

No

Contractor/Homebuilder Name *

Contact Person Name *

Contractor/Builder Mailing Address *

City *

State *

Zip Code *

Contractor/Builder Phone Number *

Contractor/Builder Cell Phone Number

Contractor/Builder Email Address *

Other Email Address

SITE INFORMATION

Site/Project Address *

Township/City/Village project located within *

Site/Project Parcel # *

Project Type *

Please indicate what type of project *

Watershed project is within *

Total property acreage *

Total Approximate Project Disturbed Acreage
(including all grading and septic area if applicable) *

Proposed (approximate) construction start date * +

Proposed (approximate) construction end date * +

CERTIFICATION *

By checking this box and providing your name and signing below, I certify under penalty of law that this document and all attachments were prepared under my direction or supervision and are to the best of my knowledge and belief, true, accurate and complete. I authorize the Geauga Soil and Water Conservation District (SWCD) agents to enter this property for the purposes of plan review, site inspection or compliance with the Water Management and Sediment Control Regulations for the duration of the project until the Geauga SWCD can close the project and all bare soil is stabilized with vegetation.

Please Sign *

clear

Type Name Signed above *

Affiliation *